Paper on sanitation determinants in rural Jharkhand, India

  • pepino
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Paper on sanitation determinants in rural Jharkhand, India

Dear colleagues,
I would like to share our latest paper on " Social determinants of environmental health: A case of sanitation in rural Jharkhand " Science of The Total Environment, 643, 762–774.

It should be freely accessible through THIS LINK for next 50 days.

Highlights
• Cross-sectional analysis of household-level sanitation drivers in rural Jharkhand
• Identified low availability of toilets accompanied with their inconsistent use
• Low demand and perceived risks didn't explain variation in sanitation outcomes.
• Key importance of descriptive social norms but adverse effects of injunctive norms
• Structural barriers should be addressed together with social norms and attitudes.

Abstract
An estimated 56% of households in rural India defecated in the open in 2015, making India the most significant contributor to the global sanitation burden. This cross-sectional study uses data collected in 2016 from 499 households in rural Jharkhand to understand the constraints of latrine adoption and drivers of sanitation preferences (plans to adopt toilets and willingness to pay for toilets). Focusing on a region with a large tribal population, the study examines two types of predictors, namely structural factors (objective socioeconomic, sociocultural and ecological characteristics) and psychosocial drivers (perceived unaffordability of toilet, hygiene and sanitation knowledge, perceived health risks, attitudes, both descriptive and injunctive social norms, and perceived water stress). We find that structural constraints related to educational, economic and sociocultural inequalities predict toilet ownership. Low sanitation rates can neither be attributed to a lack of expressed demand nor lack of recognition of the disadvantages of open defecation. Similarly, variations in sanitation preferences are neither explained by differences in hygiene and sanitation knowledge nor by understandings of sanitation health risks. We find that perceived unaffordability, attitudes (perceived benefits of toilet and disadvantages of OD) and perceived descriptive social norms are of key importance. This implies a potential for persuasive strategies that manipulate social norms around sanitation, particularly if they simultaneously address perceptions around financial unaffordability of toilets and around the benefits of toilets. Importantly, however, attempts to change sanitation preferences by acting on forces of social (dis)approval (i.e. through perceived injunctive social norms) may be ineffective and generate negative unintended consequences.

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  • muench
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Re: Paper on sanitation determinants in rural Jharkhand, India

Dear Pepino/Josef,

Thanks for posting your paper here. I copy the conclusion section here (with bold highlighting added by me to indicate what I found particularly interesting):

5. Conclusions

Improving sanitation should be conceived as a gradual process. It may be activated by a contextually appropriate sanitation intervention but it is unlikely that sustainable change will be achieved through specific interventions alone without addressing structural constraints related to educational, economic, and sociocultural inequalities. Although our findings warn against one-sided understandings that incline towards the latrine-first or demand-first narrative, the deep pervasiveness of the latrine-first narrative remains a core challenge for efforts to improve sanitation in India.

Low sanitation rates were neither explained by a lack of expressed demand nor by a lack of recognition of OD disadvantages. Similarly, neither variation in hygiene and sanitation knowledge nor understandings of health risks was associated with sanitation preferences. The documented key importance of perceived descriptive social norms implies a potential for persuasive strategies that manipulate social norms around sanitation, particularly if combined with efforts to heighten the perception of toilet benefits (privacy, comfort, safety as well as health benefits).

However, our study revealed uncertain and potentially adverse effects of perceived injunctive social norms. This important finding implies that attempts to change sanitation preferences and behaviours by acting on the forces of social (dis)approval may be ineffective in the present context and may generate negative unintended consequences. Our results thus cast doubts on the effectiveness of techniques that use negative emotions and social pressures, even if disregarding their ethical controversies. Specifically, this applies to the “name-and-shame” strategy promoted under SBM. The perception of financial unaffordability of toilets is another important area that should be addressed to improve sanitation preferences. This particularly holds if targeted together with positive pressures on descriptive social norms.


Have you followed the discussion thread about caste in India (and self perception) that Depinder started here:
forum.susana.org/71-behaviour-change-and...dia-and-caste-issues

Would be interesting to hear your thoughts on that issue (in that thread).

What were your findings with regards to caste in this research? Were the 500 households that were analysed in your study across all castes, or mainly from one caste?

Also could you give some examples about those social norms that you mentioned in your conclusions? What are the biggest social norms hindering toilet adoption? Which are the easiest social norms that could perhaps be changed and lead to beneficial outcomes (low hanging fruit)?

Regards,
Elisabeth

P.S. A related paper by Pepino (Josef Novotny) was discussed here: "Contextual factors and motivations affecting rural community sanitation - a systematic review" forum.susana.org/71-behaviour-change-and...-a-systematic-review

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Dr. Elisabeth von Muench
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  • pepino
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Re: Paper on sanitation determinants in rural Jharkhand, India

Dear Elisabeth,
thanks for your interest in our paper. Our research was conducted in a specific region with a large tribal population and low latrine coverage (15% before the start of Swachh Bharat Mission). As in many other surveys, we recorded social category (SC, ST, OBC...) and not caste differentiation itself. I am afraid that in our context the latter was not well captured by the former. In our data, religion was significantly associated with latrine ownership (lower for Sarna families, meaning the "worshipers of nature") but not with sanitation preferences and other psychosocial constructs (althought there was a correlation between religion and social category, social category was statistically insignificant with respect to measured sanitation outcomes). Our intepretation is that structural inequalities rather than differences in psychosocial/behavioural constructs determined lower sanitation rates of Sarna families. Our results do not support argments about the "preferrence for open defecation in India" that would be directly related to social-cultural differentiation. However, a specific context of our survey as well as other limitations should be kept in mind.

Regarding your question on social norms, attempts to measure social norm perceptions should not be confused with a descriptive characterisation of specific socio-cultural taboos that are often referred to in sanitation literature (although the latter may be important determinant of the former). We mesured the perception of descriptive norms related to latrine use and/or open defecation and of injunctive norms. Descriptive norms comprised opinions on the prevalence of OD or latrine use, whereas injunctive social norms captured opinions on social (dis)approval for the behaviours. Interestingly, we found a negative statistical relationship between the two aspects of social norms perception and attempted to show that while descriptive norms are important correlates of both latrine ownership and sanitation preferences injunctive norms may have adverse effects, eg becuase they amplify negative effect of perceived unaffordability of toilets on sanitation preferences (unlike descriptive norms which tend to weaken this effect).

Although our research findings may sound as overly-academic, I think that our results well correspond and provide some support to critical comments of practitioners on attempts to induce sanitation through creating negative pressures (as a means to catalyze injunctive norms).

In our previous paper from very different context of rural Ethiopia we explored different mechanisms through which social norms perception may influence sanitation (see this link )

Best,
Josef
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  • depinder
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Re: Paper on sanitation determinants in rural Jharkhand, India

Thanks for sharing the findings.

This confirms a research study findings we had done in 2015, where Jharkhand was one of the states of a 3 state study.

The study had concluded that knowledge and awareness of benefits and costs of sanitation is not a barrier to toilet adoption. But rather deeper self perceptions on either social status(low caste and work) or low aspirations of improvement in life(in a tribal context o Jharkhand where caste factors may not be prevalent).

Kindly see
indiawashforum.com/wp-content/uploads/20...ve-Research-2016.pdf
scbp.niua.org/content/sanitation-behaviour-change-research-2016

CLTS can be useful as a trigger for community engagement and action but unless it is combined with more persuasive(positive encouragement and cost subsidy in hard rock areas or where water is a problem), initial gains in toilet use may be temporary at best.

Depinder Kapur is a senior Development and WASH expert and is currently leading the Sanitation Capacity Building Platform of National Institute of Urban Affairs in New Delhi. He has worked with AKRSP, SPWD, CARE(Director NRM), Oxfam(Program & Advocacy Director), WaterAid India(Country Head) and WSSCC(National Coordinator). Also has 5 years of work experience as a consultant with UNICEF, FAO, WSSCC, FES and World Bank. Principal Trustee of India WASH Forum and part of a Citizens Initiative on Right to Water and Sanitation. Also worked with Ministry of Urban Development for the Clean India...
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  • pepino
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Re: Paper on sanitation determinants in rural Jharkhand, India

Deer Depinder,
it is nice to see that our findings from Jhrakhand are similar to yours in several respects, incl. those on the role of caste/social stratification. Thanks for the reference to your work which I didnt know. It is eveident that one should be careful when making generalisations about the effects of specific sanitation drivers. Social and geographical context matter as well as the stage of "sanitation transition" of a given community and region. If aproved, we will re-survey the same communities in Jharkhand at the end of Swachh Bharat to see the change.
Regards,
Josef
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